Introduction to the MSK toolkit

Musculoskeletal (MSK) conditions are the most common form of physical disability worldwide with one in five GP consultations being related to MSK chronic pain [1]. The exact incidence of foot pathology associated with MSK conditions is unknown, yet there is a suggested range of 3-26% of the population experiencing foot-related MSK pathologies [2,3]. Presenting MSK pathologies that can be managed within the scope of podiatry range from generalised foot osteoarthritis, inflammatory disease, paediatric growth and development, sports injuries, fragility and falls risk and neurological conditions.

The basis of podiatry intervention is developed through an accurate diagnosis of the pathology accompanied by analysis of gait and human movement biomechanics related to the presenting complaint. From this diagnostic information a suitable treatment plan is agreed upon and may include exercise therapy, functional foot orthoses or insoles, footwear, acupuncture, steroid injections, shockwave therapy, self-care and social prescribing.

Provision of assessment and care can vary depending on the development of MSK podiatry services within a trust. A recent review of 32 NHS podiatry MSK services [4] highlighted that on average there were 5.2 podiatrists working specifically in MSK with an average of 3.42 designated clinics a week that focus on a speciality.

However, there are large discrepancies in available services with just 60% of services being able to request diagnostic imaging and only 35% having access to plantar pressure measurement systems. Similarly, from the same review, 60% of services provide palpation guided steroid injections, 25% acupuncture and 13% shockwave therapy indicating a wide variation in care across the country.

Notes:

1  Ingram, M. and Symmons, D.P., 2018. The burden of musculoskeletal conditions. Medicine, 46(3), pp.152-155.
2  Ferguson, R., Culliford, D., Prieto-Alhambra, D., Pinedo-Villanueva, R., Delmestri, A., Arden, N. and Bowen, C., 2019. Encounters for foot and ankle pain in UK primary care: a population-based cohort study of CPRD data. British Journal of General Practice, 69(683), pp.e422-e429.
3  Francis, P., Whatman, C., Sheerin, K., Hume, P. and Johnson, M.I., 2019. The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review. Journal of sports science & medicine, 18(1), p.21.
4  NHS MSK Podiatry Leaders Group – members survey. Data last accessed 25th March 2021.

  

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